血液透析对老年患者血脂代谢及颈动脉超声改变的影响

Effect of hemodialysis on blood lipid metabolism and carotid ultrasound in elderly patients

目的:分析血液透析对老年患者颈动脉超声改变与血脂代谢的影响。方法:老年血液透析患者150例为透析组,年龄60~83岁,健康查体者120例做为对照组,年龄60~85岁,测定胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)、载脂蛋白A1(apoA1)、载脂蛋白B(apoB)和纤维蛋白原(FIB),所有受试者均行双侧颈动脉彩色多普勒超声检查。结果:①老年透析组TC、TG、LDL-C、apoB水平与对照组比较,差异有统计学意义(P<0.05),老年透析组FIB与对照组比较,差异有显著统计学意义(P<0.01);②老年血液透析组颈动脉内-中膜明显增厚,斑块检出率及动脉狭窄率与对照组比较,差异有显著统计学意义(P<0.01)。结论:血液透析可以影响老年患者血脂代谢及颈动脉超声改变,主要使血管内皮功能产生障碍,加速颈动脉粥样硬化进程,颈动脉超声检查可以反映老年血液透析患者血管病变的程度,为治疗及预防提供一定依据。

Objective: To analyze the effect of hemodialysis on carotid ultrasound and lipid metabolism in elderly patients.Methods: One hundred and fifty elderly hemodialysis patients and 120 normal subjects were selected as the elderly hemodialysis group(age 60~83) and the control group(age 60~85). Cholestero(TC), triglyceride(TG), high-density lipoprotein(HDL-C), lowdensity lipoprotein(LDL-C), apolipoprotein A1(apo A1), apolipoprotein B(apo B) and fibrinogen(FIB) were measured. All subjects underwent bilateral carotid color Doppler Ultrasonic examination. Results: The levels of TC, TG, LDL-C and apo B in the elderly hemodialysis group were significantly higher than those in the control group(P<0.05). The FIB in the elderly hemodialysis group was significantly higher than that in the control group(P<0.01). There were significant differences in the carotid intimamedia thickening, plaque detection rate and artery stenosis rate between the elderly hemodialysis group and the control group(P<0.01). Conclusion: Hemodialysis can affect the metabolism of blood lipid and the change of carotid ultrasound in elderly patients, mainly make the vascular endothelial dysfunction, accelerate the process of carotid atherosclerosis. Carotid ultrasound can reflect the degree of vascular disease in elderly hemodialysis patients, and provide some basis for treatment and prevention.